Search

PURPOSE OF REVIEW To review recent trials and reassess cardiovascular risk in people with diabetes. RECENT FINDINGS Recent clinical trials have tended to focus on lower-risk participants with diabetes who have had event rates considerably lower than participants in the early lipid trials. Statin studies have generally shown benefit in those without cardiovascular disease and at lower levels of low-density lipoprotein cholesterol. Results of fibrate and glitazone studies have been mixed; the question of benefit among statin-treated patients remains unanswered. Investigators failed to confirm the benefits of glucose control observed in the original Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction study possibly due to study design issues. Epidemiologic follow-up of the Diabetes Control and Complications Trial showed sustained benefit of glucose control. A number of studies have shown the benefit of inpatient control of blood glucose. We await the results of ongoing blood pressure trials and other ongoing trials, which should provide much new information. A conceptual model of cardiovascular risk for people with diabetes mellitus based on the UK Prospective Diabetes Study outcomes model is discussed. SUMMARY The majority of adults with diabetes have a substantially greater risk compared with those without diabetes and a small percentage has very high risk. A minority of individuals may have considerably lower 10-year risk.

G-to-T transversion at codon 249 of the p53 gene has been shown to be specifically associated with human hepatocellular carcinomas, particularly that subset associated with exposure to the chemical hepatocarcinogen aflatoxin B1. We surveyed 47 North American adult hepatocellular carcinomas and three childhood liver tumors for codon 249 mutation. We report here a case of childhood hepatoblastoma in a patient, without known exposure to aflatoxin B1 or hepatitis B or C virus, whose tumor had a mutation at codon 249 involving G-to-T transversion. (HEPATOLOGY 1993;18:566–569.)

This prospective study investigated predictors of repeat pregnancies by 12 months after the delivery of a first child and their outcomes in inner-city adolescent mothers. The sample included four groups: those who had therapeutic abortions, miscarriages, full-term deliveries, and no repeat pregnancy. The therapeutic abortion group had more pregnancies before their first delivery (41%) than did full term (20%) and no repeat (15%), p less than .01. More delayed grade placement was found in therapeutic abortion -1.6 years (1.3) and full term -1.8 years (.9) than in no repeat pregnancy -.6 years (1.1), p less .001. Reading achievement scores were higher in no repeat 86.3 (17.1) than in full term 75.0 (16.5), p less than .05. School attendance was higher in no repeat (65%) than in therapeutic abortion (35%) and full-term (24%) p less than .01 groups. Depressive symptoms at baseline were higher among therapeutic aborters 18.9 (9.9) than among full term 10.2 (8.2) and no repeat pregnancy groups 12.2 (6.2). Logistic regression analyses identified delayed grade placement as the most important predictor of pregnancy outcome.The purpose of this prospective study of 120 black and Puerto Rican adolescent mothers recruited from an urban adolescent health center was 1) to identify multiple predictors of repeat pregnancies and their outcomes, and 2) to assess the relative contribution of these predictors to repeat pregnancies. Variables include demographic factors, frequency of sexual activity, contraceptive method used, occurrence of pregnancies before the first delivery, educational attainment, and levels of depressive symptoms by 3 weeks postpartum. Pregnancy outcomes included mothers who terminated their pregnancy, who delivered a live birth, and who had a miscarriage; data were available 12 months postpartum. The mean age was 17.13 years. 52% were black and 44% were Puerto Rican and of low socioeconomic status. Reliability of self-reports was 95%. 60.3% had no repeat pregnancy and 39.6% became pregnant during the 1-year followup, of which 15.3% had a therapeutic abortion, 6.3% miscarried, and 18.1% carried to term. There were no significant differences in the characteristics of the repeat and nonrepeat pregnancy groups. The procedure involved interviews at 2-4 weeks (time 1), 6-7 months (time 2), and 12-13 months (time 3). Measures for delayed grade placement, reading achievement, career aspirations and socioeconomic status of the family, and school attendance are described. Multivariate analysis, univariate analyses, and Duncan multiple range tests were conducted as well as logistic regression model construction. The significant predictors of pregnancy outcome (repeat pregnancy) were having 2 or more previous pregnancies. The abortion group was twice as likely to have had a pregnancy before the birth of the first child (41%) than the full-term (20%) and the no-repeat groups (15%). There were no differences in frequency of sexual activity or contraceptive method used. In the no-repeat and miscarriage groups, grade placement was less delayed. In the no-repeat group, reading achievement scores were higher than in the full-term group. There were no differences in career aspirations. 65% of the no-repeat group were attending school at time 2 while only 35% of the therapeutic and 24% of the full-term groups were attending school. Depressive scores were significantly higher for the abortion group. Delayed grade placement was the only predictor independently associated with the increased log odds of repeat pregnancy.